Professor Jill Ehrenreich-May has created a new treatment guide that draws on cognitive behavioral strategies to treat anxiety, depression, and other emotional disorders in a shorter time span.
Years after treating a young client for severe anxiety disorder that hindered her from leaving home often—making school increasingly difficult—psychology professor Jill Ehrenreich-May received a letter from the new college student.
The young woman described her drastic transformation and wrote that because of learning how to face her fears in therapy, she realized that she could also face other life challenges.
"This idea that she didn't have to avoid the things that are scary became a mantra to her and extended to other areas of her life—to volunteer, to try a new sport, or to do things she wouldn't have tried before," said Ehrenreich-May, who is also associate chair of graduate studies in psychology at the University of Miami's College of Arts and Sciences. "It really seemed to change the trajectory of her life, and to be able to provide that type of experience to someone is such a gift."
It also underscored to Ehrenreich-May the power of a simple, not often utilized form of treatment to tackle anxiety and phobias—exposure therapy. While it is a well-known type of cognitive behavior therapy, few therapists outside of specialty care settings use the method because it seems challenging to apply properly. But Ehrenreich-May is hoping to change that.
She is a fervent advocate of the therapy, which is one of a host of strategies she recommends to treat anxiety, depression, and other emotional disorders, like obsessive-compulsive and tic disorders. Ehrenreich-May also teaches these treatment strategies to clinical graduate students who serve as therapists at her Child and Adolescent Mood and Anxiety Treatment (CAMAT) Program that treats up to 200 youth and families per year in group, telehealth, and individual therapy settings.
Her expertise in helping young patients overcome mental health challenges comes from years of research and experience as a therapist herself.
Before coming to the University of Miami, Ehrenreich-May began developing what would become two published treatment manuals—the Unified Protocols for Transdiagnostic Treatments of Emotional Disorders in Children (UP-C) and Adolescents (UP-A). These guides give therapists, psychologists, and parents an array of research-based strategies to help children and young adults suffering from a range of emotional disorders in a quicker time span. They rely heavily on cognitive behavioral strategies, which are research-based tools that stress the importance of shifting a person's perspective, as well as their patterns of behavior, to help them learn how to cope with difficult situations.
"Long ago, exposure-based therapies were a bit of a shock to those doing traditional 'talk therapies' that lasted for years, because they achieved good outcomes in terms of symptoms, for conditions like anxiety and related concerns in just 8 to 16 sessions," she said. "It really turned the field on its ear with the idea that you could create positive change for more than 60 percent of clients in a shorter amount of time."
In addition to her research, Ehrenreich-May also makes a point to stay involved in the psychology community. She was recently named president of the Association for Behavioral and Cognitive Therapies (ABCT), an organization that champions the science behind psychotherapy, with nearly 5,000 members across the nation. In this role, Ehrenreich-May said that she is hoping to highlight how the UP-A and UP-C, along with other effective treatments, can be used to help an overflowing pool of children, teens, and adults dealing with mental health challenges.
"My primary goal now is to make sure effective therapies for youth reach a larger audience of clinicians and families," she said. "ABCT provides a terrific platform to help support that goal."
Ehrenreich-May said she was drawn to treating children and teens using cognitive behavioral therapy strategies because she has seen them work firsthand. Although her time is now focused on research and training a new generation of therapists, Ehrenreich-May honed her love of these approaches by providing exposure therapies to youth for a variety of concerns—from fears of costumed characters, to obsessive thoughts about contamination, to worries about having panic attacks.
"You are treating something like avoidance or withdrawal behavior that you can see progress with right in front of you over time," she added.
Since the UP-C and UP-A were published in 2017, Ehrenreich-May has worked to test, refine, consolidate, and improve them with promising results. Graduate student and CAMAT program therapist Liz Halliday said just learning about the treatments fascinated her enough that she began working with Ehrenreich-May as an undergraduate.
"What's powerful about the UP-C and UP-A is we are teaching kids and teens about their emotions and how to respond to them in really helpful ways. And these are broad enough concepts that there is an ability for them to be personalized to the individual child," said Halliday.
Lately, Ehrenreich-May has begun sharing her tools to tackle youth anxiety and depression with South Florida providers. Working with psychology professor Amanda Jensen-Doss on several grants, Ehrenreich-May led training sessions on the UP-A and UP-C with community mental health clinics in Miami-Dade and Broward counties. And this fall, Ehrenreich-May and her clinical director, Niza Tonarely-Busto, led a session with 60 mental health specialists from Miami-Dade County Public Schools. Last week, the pair held a two-day workshop with Lotus House, which shelters more than 1,550 women and children each year and offers counseling services.
"During the COVID-19 pandemic, I looked at the dramatic rise in youth anxiety and depression and figured we needed to pivot to get these strategies out there faster," Ehrenreich-May said. "So, we made ways for treatments to be briefer; we did treatment through telehealth sessions. And now [as a result of a grant], we are adapting some of our targeted treatments for anxiety or depression to be single-session virtual modules, where parents or young adults could attend day or night."
A South Florida native and mother of two, Ehrenreich-May discovered her interest in psychology at the University of Florida where she began doing research with counseling psychology professor Carolyn Tucker. At the time, Tucker was operating an afterschool research program at churches in Gainesville to support healthy behaviors and academic achievement in Black youth. Soon, Tucker hired Ehrenreich-May as an undergraduate project coordinator and inspired her to delve further into the field.
"It was incredibly formative," Ehrenreich-May said. "Doing this prevention work in community settings with youth in need of support was such an exciting thing for me as an undergraduate, so I thought that I really wanted to keep doing this."
She earned her doctorate at the University of Mississippi, where her mentor Alan Gross helped Ehrenreich-May hone her skills in behavioral therapy. Later, while interning at the University of Chicago, her next mentor, Daniel Le Grange, opened Ehrenreich-May's eyes about how to fuse behavior therapy and family interventions to help teens struggling with anorexia and bulimia.
During her first faculty position at Boston University, Ehrenreich-May worked as a therapist at the Center for Anxiety & Related Disorders. After treating youth for various emotional disorders by consulting a host of manuals for each condition, she thought it would be more efficient to consolidate them. With the help of an early career grant from the National Institutes of Health, Ehrenreich-May started to craft the UP-A and UP-C (which also include a parent manual) in Boston and later finished the project in Miami.
By combining several approaches into one treatment, the UP-A and UP-C can provide faster help for individuals suffering from multiple conditions, which is appealing for therapists with a high volume of clients.
"It's a more flexible, applicable tool than other treatments out there," said Jensen-Doss, who studies training methods for mental health therapists. "Before Jill adapted it for children and teens, there was an adult version. But often mental health issues start in adolescence, so hopefully these tools will help us intervene earlier and get young adults on a better development trajectory over time."
In the past six years, the popularity of Ehrenreich-May's manuals has grown tremendously. Halliday said the UP-A has been adapted for many other problems, including eating disorders, and more serious mental illnesses, such as bipolar disorder or schizophrenia. In addition, a professor from Spain adapted some of its strategies for primary schools and the programs have been tested in several international settings. Today they are used to not simply treat, but also to help prevent children from developing anxiety, depression, and related conditions.
Now, Ehrenreich-May wants to make the Unified Protocols more culturally responsive so that they can reach more underrepresented youth.
"It is one of our lab's highest priorities to test these interventions in settings with more diverse populations and with children that have been underrepresented historically," she said. "I want to refine our approach to be more inclusive in all ways, to help the widest array of kids possible."
